“Caught between a rock and a hard place” – between discourses of empowerment and solicitude.:An empirical study on Danish public sector service professionals’ discourses of non-attendance

Nonattendance constitutes a profound challenge in public sector services targeting young adults with mental health difficulties. Therefore, researchers and practitioners are occupied with trying to resolve this. For clinicians to be aware of their own naturalized and perhaps inappropriate communicative practices, we investigated the established normative organizational logics behind explanations and strategies related to nonattendance. We performed a critical discourse analysis on material collected through participatory research throughout 2015. Three discourses were identified: solicitude, responsibility, and youth discourse. Although the discourses were complex and entangled, they were used by all practitioners. Furthermore, some of the discourses, especially the responsibility and the solicitude discourses, were inherently tension filled, and practitioners experienced frustration in dealing with these tensions. The youth discourse can be understood as a coping mechanism to deal with these tensions because it distributes responsibility for nonattendance to general social and cultural processes. </jats:p

Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder:Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial

Abstract Background Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the \u201cThe Unified Protocol for Transdiagnostic Treatment of Emotional Disorders\u201d (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. Methods/design The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6\ua0months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence. Discussion The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect. Trial registration Clinicaltrials.gov NCT02954731 . Registered 25 October 201

Bedside Ipad videooptagelser som læringsredskab i klinisk psykiatri

I artiklen ser vi på potentialer og udfordringer ved at benytte iPads til at understøtte lægestuderendes læring under deres klinikophold i psykiatri. 72 studerende er blevet instrueret i at bruge iPads til at filme patientsamtaler og gennemse deres videoer med henblik på, at udvælge dele af videoen som udgangspunkt for supervision med en læge. Interviews med de studerende peger på, at supervision med udgangspunkt i videoer på iPaden giver mulighed for mere detaljeret læring, end supervision uden samme mulighed for at visualisere patientsamtalen. Dog stiller de studerede spørgsmålstegn ved, om læringsudbyttet ved at bruge iPads svarer til den tid, de bruger på at filme og se filmen igennem. De foretrækker mere klassisk supervision og feedback